Regression of Coronary Aneurysms With Intravenous Immunoglobulins and Steroids for COVID-19 Adult Multisystem Inflammatory Syndrome

Abstract

A multisystem inflammatory syndrome mimicking Kawasaki disease has been increasingly reported, mainly in children, in the context of coronavirus disease-2019 (COVID-19). We report on the first case of coronary aneurysm resolution after treatment with steroids and intravenous immunoglobulins in an adult patient with multisystem inflammatory syndrome temporally associated with COVID-19. ( Level of Difficulty: Beginner. )

Multisystem inflammatory syndrome in adults: a case report and review of the literature

“…Like our case report, sore throat was present in five patients (5/36; 14%) [4][5][6][7][8] and unilateral cervical pain/swelling in four other cases (6/36; 16%) [8][9][10][11][12]. Some patients had predominant visual symptoms [5,[13][14][15][16][17]. Cardiovascular impairment was also noted in the literature.…”

“…Specifically, tachycardia (22/36; 61%) and hypotension/cardiogenic shock with documented impaired ejection fraction (23/36; 64%) [5-8, 10, 12, 15, 17-24]. The left ventricular function/ejection fraction normalized with treatment in 15 patients [6,7,12,17,21,23,24], of whom 7 patients received IVIG with or without aspirin [10,12,17,23,24]. Overall, 28/36 (78%) patients recovered and were safely discharged.…”

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

“…A total of 221 patients with MIS-A were identified: 102 were from the CDC’s MIS-C surveillance system, of whom 55 were described in a recent publication 3 ; 20 were from voluntary reports to the CDC, of whom 9 were included in a recent publication 2 ; and 99 were from case reports published in the literature. 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , …”

“…In total, 449 relevant articles were identified, and 86 were selected for in-depth review; of these, 60 had data for patients with MIS-A. 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 Figure 1 summarizes...…”

“…However, efforts are needed to distinguish it from biphasic acute COVID-19. Using both RT-PCR and serologic testing for antibodies may aid in the diagnosis of MIS-A, especially among persons who had asymptomatic acute COVID-19, because IgG antibodies become detectable 3 to 4 weeks after SARS-CoV-2 infection, 75 at the time when MIS-A commonly presents (median, 28 [IQR, [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] days). In addition, owing to comorbidities, some individuals may be delayed in mounting an antibody response and have persistently positive SARS-CoV-2 RNA.…”